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CompletedNCT03447054ALCOSTIMUpdated Nov 4, 2020

Severe Alcohol-use Disorder: a tDCS and Response Inhibition Training Intervention

An interventional study of Combined TDCS active and ICT active and Combined TDCS sham and ICT active in Alcohol Use Disorder, sponsored by Brugmann University Hospital. Completed at 1 site in Belgium. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2020-11-04.

Sponsored by Brugmann University Hospital · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
136
Allocation
Randomized
Ages
18 Years to 65 Years
Sex
All
01

Study summary

Most severe forms of alcohol-use disorder are thought to reflect an abnormal interplay between two neural systems: an overly active impulsive one driven by immediate rewards prospects and a weak reflective one, tuned on long-term prospects. The investigators propose that two non-pharmacological interventions, Transcranial Direct Current Stimulation (tDCS) and Inhibitory Control Techniques (ICT) may act on both systems when combined, which might ultimately result is a reduction of alcohol relapse rate.

Read the detailed description

Treating Alcohol dependence remains notoriously difficult despite use of several medications, psychotherapeutic and psychosocial interventions. Alcohol dependence is thought to reflect an abnormal interplay between two neural systems: an overly active impulsive one driven by immediate rewards prospects and a weak reflective one, tuned on long-term prospects. The investigators proposes that two non-pharmacological interventions, Transcranial Direct Current Stimulation (tDCS) and Inhibitory Control Techniques (ICT) may act on both systems when combined. tDCS has been found to improve working memory, which is necessary to evaluate long-term consequences of actions. ICT is able to modify the automatic approach tendencies towards appetitive cues.

The investigators will recruit 160 alcohol-dependent patients and divide them randomly between four treatment conditions : real transcranial Direct Current Stimulation (tDCS) with active or control Inhibitory Control Technique (ICT ); or sham (placebo) tDCS with active or control ICT.

Patients will be evaluated with primary outcome measures (alcohol consumption patterns) and secondary outcome measures (working memory and changes in alcohol-related stimuli affective values).

02

Conditions studied

  • Alcohol Use Disorder

Keywords

  • Alcohol
  • tDCS
  • inhibition
  • cognitive training
  • implicit cognition
  • relapse
  • craving
03

Who can participate

Ages eligible
18 Years to 65 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Patients with severe alcohol-use disorder (DSM-5 criteria), hospitalized for detoxification.
  • Severity of alcohol use disorder must be at least moderate (at least 4 DSM-5 criteria)
  • Aged between 18 and 65 years
  • Comorbidity with anxiety disorders and depressive disorders is allowed
  • Patients must be illegal drug free for 3 weeks at beginning of trial
  • Pharmacotherapy: patients should be benzodiazepines free at the moment of inclusion. They are allowed to continue other psychotropic medication (antidepressants, antipsychotics, mood stabilizers), providing they are following a stable regimen that will not be changed during the protocol time.
  • Patients must be reachable for follow-up

Exclusion criteria

Exclusion Criteria:

  • Previous neurological conditions (epilepsy, traumatic brain injury, stroke)
  • Present delirium, confusion or severe cognitive disorder
  • Schizophrenia, chronic psychotic disorders, bipolar type 1 disorder.
  • Any severe, life-threatening disorders
  • High suicidal risk
  • Specific contraindications for tDCS: metallic plates in the head
  • Alcohol medication treatment initiated during the rehab: acamprosate, disulfiram, baclofen, nalmefen.
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Triple (Participant, Care provider, Outcomes assessor)
Enrollment
136 participants (actual)

Study arms

  • Experimental
    Combined TDCS active and ICT active

    Five consecutive days: Twenty minutes of TDCS on the right dorsolateral prefrontal cortex while performing an alcohol-cue inhibitory control training consisting to systematically paired go responses with non-alcohol pictures and no-go responses with alcohol-related pictures.

    Behavioral: Combined TDCS active and ICT active

  • Active comparator
    Combined TDCS sham and ICT active

    Five consecutive days: Twenty minutes of sham TDCS on the right dorsolateral prefrontal cortex, while performing a no-cue go/no-go training consisting to carry out a go/no-go paradigm with no alcohol-related content.

    Behavioral: Combined Sham TDCS and inactive ICT

  • Active comparator
    Combined TDCS active and ICT inactive

    Five consecutive days: Twenty minutes of active TDCS in association with no-cue go/no-go training consisting to carry out a go/no-go paradigm with no alcohol-related content.

    Behavioral: Combined TDCS active and ICT inactive

  • Sham comparator
    Combined Sham TDCS and inactive ICT

    Five consecutive days: Twenty minutes of Inactive TDCS combined with an non alcohol-cue inhibitory control training consisting to carry out a go/no-go paradigm with no alcohol-related content.

    Behavioral: Combined TDCS sham and ICT active

Interventions

  • BehavioralCombined TDCS active and ICT active

    Five 20-minute long sessions including TDCS (2 MicroAmperes during 20 minutes) and ICT, 5 consecutive days

    Also known as: Experimental

  • BehavioralCombined TDCS sham and ICT active

    Five 20-minute long sessions including TDCS sham (non active) and ICT, 5 consecutive days

    Also known as: Sham/active

  • BehavioralCombined TDCS active and ICT inactive

    Five 20-minute long sessions including TDCS sham and no-cue inhibition training, 5 consecutive days

    Also known as: Sham/inactive

  • BehavioralCombined Sham TDCS and inactive ICT

    Five 20-minute long sessions including TDCS and no-cue inhibition training, 5 consecutive days

    Also known as: Active/inactive

05

What researchers measure

Primary outcomes

  1. Reduction of alcohol use in post-treatment at week 2

    Based on self-report questionnaires (grams of ethanol/occasion, per/day, number of consecutive days of alcohol drinking)

    Time frame: é weeks post-rehab

  2. Reduction of alcohol use in post-treatment at week 4

    Based on self-report questionnaires (grams of ethanol/occasion, per/day, number of consecutive days of alcohol drinking)

    Time frame: 4 weeks post-rehab

  3. Reduction of the relapse rate in post-treatment at week 2

    Based on self-report questionnaires and on one other significant person's feedback; binary outcome (relapser or non-relapser)

    Time frame: 2 weeks post-rehab

  4. Reduction of the relapse rate in post-treatment at week 4

    Based on self-report questionnaires and on one other significant person's feedback; binary outcome (relapser or non-relapser)

    Time frame: 4 weeks post-rehab

  5. Reduction of alcohol use in post-treatment at week 12

    Based on self-report questionnaires (grams of ethanol/occasion, per/day, number of consecutive days of alcohol drinking)

    Time frame: 12 weeks post-rehab

  6. Reduction of the relapse rate in post-treatment at week 12

    Based on self-report questionnaires and on one other significant person's feedback; binary outcome (relapser or non-relapser)

    Time frame: 12 weeks post-rehab

  7. Reduction of alcohol use in post-treatment at week 24

    Based on self-report questionnaires (grams of ethanol/occasion, per/day, number of consecutive days of alcohol drinking)

    Time frame: 24 weeks post-rehab

  8. Reduction of the relapse rate in post-treatment at week 24

    Based on self-report questionnaires and on one other significant person's feedback; binary outcome (relapser or non-relapser)

    Time frame: 24 weeks post-rehab

Secondary outcomes

  1. Cue reactivity (attractiveness) at day 22

    measures of attractiveness of used and novel alcohol-related pictures: Likert scale ranging from not (score of 0) at all to very much (score of 9)

    Time frame: at post-intervention (day 22 of hospitalization)

  2. Cue reactivity at day 22

    measures of attractiveness of used and novel alcohol-related pictures: Likert scale ranging from not (score of 0) at all to very much (score of 9)

    Time frame: at post-intervention (day 22 of hospitalization)

  3. Cue reactivity (valence) at day 22

    emotional content (valence) of pictures used in the response inhibition practice and of new pictures. Likert scale ranging from not (score of 0) at all to very much (score of 9)

    Time frame: at post-intervention (day 22 of hospitalization)

  4. Cue reactivity (arousal) at day 22

    emotional content (arousal) of pictures used in the response inhibition practice and of new pictures. Likert scale ranging from not (score of 0) at all to very much (score of 9)

    Time frame: at post-intervention (day 22 of hospitalization)

  5. Cue reactivity (alcohol verbal fluency) at day 12

    Alcohol verbal fluency (from Goldstein et al., 2007; Drug and Alcohol Dependence, 89:97-101 and Hon et al., 2016, Psychopharmacology, 233: 851-861: Participants are instructed to name as many alcohol-related words as possible in 1 min. Responses were audio recorded and independently coded into three categories: neutral, positive and negative valence by two researchers.

    Time frame: at baseline (day 12 of hospitalization)

  6. Cue reactivity (alcohol verbal fluency) at day 22

    Alcohol verbal fluency (from Goldstein et al., 2007; Drug and Alcohol Dependence, 89:97-101 and Hon et al., 2016, Psychopharmacology, 233: 851-861: Participants are instructed to name as many alcohol-related words as possible in 1 min. Responses were audio recorded and independently coded into three categories: neutral, positive and negative valence by two researchers.

    Time frame: at post-intervention (day 22 of hospitalization)

  7. response inhibition at day 12

    stop signal task (Logan, 1994): Stop Signal Reaction Time measure

    Time frame: at baseline (day 10 of hospitalization)

  8. response inhibition at day 22

    stop signal task (Logan, 1994): Stop Signal Reaction Time measure

    Time frame: at post-intervention (day 22 of hospitalization)

06

Study locations

1 site
  • CHU-Brugmann
    Brussels, ++32, Belgium
07

References and documents

Publications

  • Dubuson M, Kornreich C, Vanderhasselt MA, Baeken C, Wyckmans F, Dousset C, Hanak C, Veeser J, Campanella S, Chatard A, Jaafari N, Noel X. Transcranial direct current stimulation combined with alcohol cue inhibitory control training reduces the risk of early alcohol relapse: A randomized placebo-controlled clinical trial. Brain Stimul. 2021 Nov-Dec;14(6):1531-1543. doi: 10.1016/j.brs.2021.10.386. Epub 2021 Oct 20. PubMed 34687964 ↗

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT03447054
Lead sponsor
Brugmann University Hospital
Collaborators
University Ghent, Université Libre de Bruxelles
Responsible party
Xavier NOËL (Research Associate at the F.R.S/FNRS, Brugmann University Hospital) — Principal investigator
First posted
Feb 27, 2018
Start date
Jan 1, 2018
Primary completion
Mar 18, 2020
Completion
Sep 1, 2020
Last update
Nov 4, 2020

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
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